摘要
微创外科的发展近20年来,经历了器官切除、以血管为中心的根治性器官切除和基于膜解剖的功能性根治性器官切除3个发展阶段。随着高清腹腔镜的推广,外科医师逐渐观察到开放手术中无法肉眼识别的膜间隙和膜结构。膜解剖的兴起与发展,让我们不断地发现以往未曾认识到的膜间隙与膜结构。受龚建平教授膜解剖理念的启发,笔者通过腔镜与机器人的高清视野,结合临床实践,对基于膜解剖的腹腔镜结直肠癌根治术进行了系统化的观察和阐述,对右半结肠、左半结肠和直肠手术的膜解剖结构、膜间隙进行了探索,并通过反复的外科操作与实践验证,对膜解剖理论进行了系统研究,提出了"小肠与升结肠系膜间隙"、"横结肠系膜根"与"TME终点线"等膜解剖结构。该套理论可促进"微出血"或"无血"微创结直肠外科手术的稳定开展。
During the past 20 years, the development of minimally invasive surgery had developed through three stages: organ excision, radical organ excision centered on arteries and functional radical organ excision based on membrane anatomy.While high-definition laparoscopy was gaining more popularity, surgeons gradually observed the fascial spaces and fascial structures which could not be recognized by naked eye during open surgery. With the development of membrane anatomical architecture, we discovered several fascial spaces and fascial structures that had never been recognized before. Inspired with the anatomical concept, proposed by Professor Gong Jianping, we systematically observed and expounded the laparoscopic radical surgery for colorectal cancer based on membrane anatomy, and explored the fascial anatomy structure and fascial space during operations for right semicolon, left semicolon and rectum through the high-definition visualization of the endoscope and robot in combination with clinical practice. Meanwhile, the membrane anatomy theory was systematically studied through repeated surgical operations and verified through practice. The fascial anatomy structures, such as "space between small intestine and ascending mesentery","transverse mesocolon radix" and "terminal line of total mesorectal excision" were proposed. This theory can promote the stable development of "microbleeding" or "no blood" minimally invasive colorectal surgery.
作者
池畔
王枭杰
Chi Pan;Wang Xiaojie(Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第5期406-412,共7页
Chinese Journal of Gastrointestinal Surgery
基金
国家临床重点专科建设资助项目(卫办医政函(2012)649号).
关键词
膜解剖
结直肠外科
微创外科
Membrane anatomy
Colorectal surgery
Minimally invasive surgery
